Symptoms/Signs of Dying Patient

Question 1

List the common signs of a dying patient.

Answer 1

○ Delirium, agitation delirium
○ Functional decline
○ Change in conscious state
○ Secretions: gurgling sounds from the chest due accumulated secretions and inability to cough up and decrease fluid intake. Do not suction, only causes increase in secretions. Best Rx is change to recovery position
○ Physiological changes: BP drop
- If death is close (hours - late change):decrease perfusion - cool peripheries, change in colour, oedema;
- Cheyne Stokes breathing (oscillations of apnoea, hyperapnoea) - central

Question 2

List the common symptoms of a dying patient.

Answer 2

• Dry mouth, but not thirsty
• LoA
• Pain
• Nausea
• Restlessness
• Fatigue
• Dyspnoea

Question 3

How do we manage dyspnoea in a dying patient?

Answer 3

Morphine - suppresses the feeling of breathlessness, depresses respiratory centre and is an anxiolytic

Question 4

How do we manage agitation?

Answer 4

Haloperidol

Question 5

What is terminal agitation and how do we manage it?

Answer 5

It is the terminal restlessness of a patient - they attempt to get up from bed and lead to fatal falls.
Therefore use a sedating agent - levomepromazine in high dose (low dose is anti-nausea)

Question 6

Most chronic medications are ceased, but certain medications are retained. What are these and why?

Answer 6

• Pain medication is continued as a conversion to equivalent to SC
• Anti- emetics
• Benzodiazepines: if it was chronically used as it has bad w/drawal Afx
• Anticonvulsants: only come in oral form, therefore start benzodiazepine instead SC